Immune response to hepatitis B virus vaccination among HIV-1 infected and uninfected adults in Kenya

Abstract

Background: In studies from high-income countries, human immunodeficiency virus type 1 (HIV-1)-infected persons have diminished responses to hepatitis B virus (HBV) vaccination, compared with HIV-1-uninfected persons, but data from other settings are limited.

Methods: We compared the immune response to HBV vaccination among HIV-1-infected and HIV-1-uninfected Kenyan adults and assessed the response of HIV-1-infected initial nonresponders to revaccination with a standard HBV vaccine series.

Results: Of 603 participants, 310 (51.4%) were HIV-1-infected, for whom the median CD4(+) T-cell count was 557 cells/μL (interquartile range, 428-725 cells/μL); none were receiving antiretroviral therapy. Nonresponse to HBV vaccine was higher among HIV-1-infected participants, compared with HIV-1-uninfected participants (35.8% vs 14.3%; odds ratio, 3.33; P < .001). Of 102 HIV-1-infected initial nonresponders, 88 (86.3%) responded to revaccination, for an overall response, including to revaccination, of 94.9%. Among HIV-1-infected individuals, lower CD4(+) T-cell counts and male sex were independent predictors of nonresponse to initial vaccination, and lower body mass index, higher plasma HIV-1 RNA levels, and longer time to revaccination predicted nonresponse to revaccination.

Conclusions: Kenyan adults had similar HBV vaccination responses as persons from high-income countries. Timely revaccination of HIV-1-infected nonresponders increased response to the vaccine to 95%.

Figure 1.

Study participants and hepatitis B virus (HBV) vaccine immune response rates, by human immunodeficiency virus type 1 (HIV-1) status. Participants who were susceptible to HBV infection at enrollment into the Partners PrEP Study, completed the vaccination schedule, and had an archived blood sample collected 6 months after completion of the standard HBV vaccination series and their immune response rates, by HIV-1 status.

Figure 2.

Hepatitis B virus (HBV) vaccine immune response among human immunodeficiency virus type 1 (HIV-1)–infected initial nonresponders. Immune response to HBV standard dose revaccination after 1 additional dose or 3 additional doses among HIV-1–infected initial nonresponders. Abbreviation: HBsAb, HBV surface antibody.

Figure 3.

Cumulative proportion of response to additional doses of hepatitis B virus (HBV) vaccine among human immunodeficiency virus type 1 (HIV-1)–infected participants. Plot showing the cumulative proportion with immune response to additional doses of standard HBV vaccine among HIV-1–infected participants. Immune response was determined 6 months after completion of the initial vaccination series and 4 weeks after the first and third revaccination doses.

Figure 4.

Response to hepatitis B virus (HBV) revaccination among human immunodeficiency virus type 1 (HIV-1)–infected initial nonresponders, by time to revaccination. Bar chart depicting the percent response to HBV revaccination among HIV-1–infected persons with initial nonresponse to vaccination, by time to revaccination. The P value for trend is also shown.